Provider Demographics
NPI:1518236876
Name:MEDSTAR AMBULANCE OF MENDOCINO COUNTY INC
Entity Type:Organization
Organization Name:MEDSTAR AMBULANCE OF MENDOCINO COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WINTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-462-3808
Mailing Address - Street 1:960 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-3412
Mailing Address - Country:US
Mailing Address - Phone:707-462-3808
Mailing Address - Fax:707-462-9561
Practice Address - Street 1:960 N STATE ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-3412
Practice Address - Country:US
Practice Address - Phone:707-462-3809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport